EXECUTIVE SUMMARY
Malaria remains a disease of public health significance in the SADC region. It is responsible for 20% of childhood deaths and in excess of 30% and 40% of outpatient visits and hospitalisations, respectively. WHO has estimated that threequarters of the population residing in this region is at risk of contracting malaria, including 35 million children younger than five years of age and approximately 8.5 million pregnant women. As national borders become increasingly porous, a harmonised and coordinated effort within the region is essential for malaria control.
It is with that intention that the SADC Secretariat has commissioned the development of harmonised regional standards for malaria. The “Malaria Elimination Pathway”, a dynamic framework that tracks Member States through the various stages of malaria control and elimination was used to analyse the findings.
A literature review followed by a site assessment visit by a group of malaria experts was used to gather information—and the findings are presented in this report. Best practices and challenges are identified across transmission zones and interventions, as well as crosscutting categories, such as policies, funding, human resources, procurement and supply, monitoring and evaluation (M&E), partner coordination and integration, gender and equity, and cross-border initiatives.
While Member States have made significant progress in several areas and are closer to achieving their Roll Back Malaria (RBM) targets, there are also several challenges that Member States need to overcome in order to achieve elimination.
For the zero-transmission Member States, there have been exemplary efforts in surveillance and “active case investigation and finding” in one of the Member States that can be replicated as a best practice across this transmission zone.
Surveillance is critical for the zero-transmission Member States to prevent reintroduction or introduction of malaria.
For low, unstable-transmission Member States, the vector control strategies (specifically indoor residual spraying, IRS) have been very successful and have exceeded the RBM targets. Successful cross-border programmes with hightransmission Member States (such as the Lubombo Spatial Development Initiative, LSDI) have brought valuable lessons.
Maintaining strong vector control strategies, as well as surveillance, to move toward elimination is the key for Member States in the low-unstable, transmission zones.
While countries in the high, stable and mixed transmission zones receive the bulk of donor funding and have introduced some commendable strategies and practices, there are also significant gaps that need to be addressed to achieve a harmonised malaria control for the region.
Across the transmission zones, policies and strategies on malaria were in place, but the dissemination to all cadres needs to be improved. Funding and resources for malaria have increased significantly, especially via the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria and the President’s Malaria Initiative (PMI), as well as via commitments from Member States themselves.
However, sufficient funding for malaria is still a challenge, specifically for middle-income Member States and cross-border programmes. Human resources were seen as a major gap, and some states were using community health workers as a task shifting measure, as well as for providing services in hard-to-reach areas.
A system is needed to monitor the quality of drugs and commodities, and the availability of unapproved and substandard drugs in the market. The consistency and quality of the data flow from the lower levels of the health system could be improved in several states. National Malaria Control Programmes (NMCP), where they exist, should take leadership in partner coordination and management. In addition, malaria should be made a ministerial priority (just as HIV and AIDS was) in order to achieve elimination.
The detailed findings from the situation and analysis report identify the areas for standards development. A brief summary of the implications of the standards is presented with each category